Lumbar Pathology

Question 1

Degenerative disc DZ

AKA: Spondylosis causes

Answer 1

Trauma, age

Question 2

Degenerative Disc DZ

AKA: Spondylosis risks

Answer 2

Smoking, repetitive movements, physical labor, trauma, genetic, obesity

Question 3

Osteoarthritis

Answer 3

Degeneration of cartilage
Stiffness, pain
Radiculopathy= pain, mm weakness
Myelopathy= direct pressure on spine, global weakness, gait, loss balance ***UB/bowel dys

Question 4

Herniated disc

Answer 4

Tears usually postero-lateral
Release chemical mediators= inflammation=pain
Pain in extremities, sensory/motor/reflex changes, paralysis, sciatica
Cauda equina= weakness/numbness/pain of butt/perenium ***UB/bowel dys

Question 5

Is herniated discs better or worse with flexion/extension?

Answer 5

Flexion=worse

Extension= better

Question 6

Which part of the herniated spine is usually asymptomatic?

Answer 6

Cervical

Question 7

Spinal Stenosis

Answer 7

Abnormal narrowing of spinal cord
Intermittent neurologic claudation= low limb numb/weakness, leg pain, weak/heavy but-> low legs, worse with prolonged standing/walking
Radiculopathy= weakness, loss sensation, loss reflexes
Clauda equina= bilateral leg pain, weak/numb butt, ***UB/bowel dys

Question 8

Is spinal stenosis better or worse with flexion/extension?

Answer 8

Flexion= better
Extension= worse

Question 9

Spondylolithesis

Answer 9

Forced displacement of vertebra
*mostly L-5
Stiff back, tight hamstrings, low back pain, slipping sensation, leaning forward position, gait, worse with cough/sneeze
Severe= waddle

Question 10

What is a backward displacement of vertebra called

Answer 10

Retrolisthesis

Less common

Question 11

Scoliosis

Answer 11

3D deviation
C/S- shape
1) congenital
2) idiopathic
3) secondary

Question 12

What are lumbar red flags

Answer 12

1) unrelenting/constant pain, at night
2) UB/bowel dys
3) saddle area paresthesia
4) bilateral sciatica

Question 13

What are lumbar myotomes

Answer 13

L2- hip flexor
L3- quads
L4- tibialis anterior
L5- extensor hallucis Longus
S 1/2- plantar flexors, peroneals

Question 14

Lumbar reflexes

Answer 14

L-2/3/4= patella
L-4/5= tibialis pos
L5/S1= medial hamstring (semitendonosis/membranosis)
S 1/2= Achilles
Bubinski= plantar

Question 15

Spondylosis

Answer 15

Degenerative disc dz

• loss fluid= less flexibility/shock absorbing
• less disc height=narrow vertebrae= less stability= nerve pressure=pain